ABC | Volume 113, Nº3, September 2019

Original Article Kang et al. Acute coronary syndrome patients Arq Bras Cardiol. 2019; 113(3):367-372 Exclusion criteria: patients with previous admissions for myocardial infarction, patients with acute myocardial infarction caused by embolus shedding, intravascular operation, or other diseases; patients who presented with cardiogenic shock, cardiac arrest and gastrointestinal bleeding upon admission; patients with acute infectious disease, malignant tumors and autoimmune diseases; pregnant women. Diagnostic criteria for related diseases: diabetes mellitus was diagnosed based on the Guidelines for the Prevention and Treatment of Diabetes in China (2013 Edition). 6 The criteria for diabetes diagnosis were based on the typical symptoms of diabetes in addition to random blood glucose ≥ 200 mg/dL and/or fasting blood glucose ≥126mg/dL and/or blood glucose level at two hours after glucose load≥200mg/dL. Hypertension was diagnosed according to the Chinese Guidelines for the Management of Hypertension in China (2015 revised edition). 7 The patient was diagnosed with hypertension when systolic blood pressure (SBP) was ≥ 140 mmHg (1 mmHg = 0.133 kPa) or diastolic blood pressure (SBP) was ≥ 90 mmHg. Dyslipidemia was diagnosed according to the Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults (2016 revised edition): 8 triglyceride (TG) ≥ 150 mg/dL, total cholesterol (TC) ≥ 201 mg/dL, low-density lipoprotein cholesterol (LDL-C) ≥ 131 mg/dL, high-density lipoprotein cholesterol (HDL-C) < 38 mg/dL, and smoking ≥ 10 cigarettes per day for more than one year. Clinical data acquisition: (1) baseline clinical and demographical data of patients were recorded, including gender, age, body mass index, smoking history, alcohol consumption, family history of CAD, and past history of diabetes, hypertension, and dyslipidemia; (2) clinical indicators were recorded within 24 hours after admission, including heart rate, SBP and DBP. Fasting blood samples were collected in the morning of the next day after admission for the laboratory tests – blood routine test (complete blood count and platelet count) was performed using an automatic blood cell analyzer; blood lipid profile (triglyceride triacylglycerol, TC, LDL-C, and HDL-C) was determined using an automatic biochemical analyzer; brain (B-type) natriuretic peptide concentration was determined by radioimmunoassay, and troponin I was determined by mass spectrometry. The echocardiographic indexes included left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter. The coronary angiography results were recorded after admission. In-hospital adverse events included acute left heart failure, cardiogenic shock, cardiac arrest and death. Statistical analysis Statistical analysis was conducted using the statistical software SPSS 22.0. Normally distributed data were expressed as mean ± standard deviation, and non-normally distributed measurement data were expressed as median and interquartile range (P25, P75), and counts expressed as percentage. Data with normal distribution were compared using independent sample t -test, non-normally distributed continuous variables were evaluated using Mann-Whitney U-test, and discrete variables were compared using Chi‑square ( X 2 ) test. The multivariate logistic regression analysis between groups for in-hospital adverse events was performed. A two‑sided test was used in the present study, and a p < 0.05 was considered statistically significant. Results Comparison of baseline data: mean age of PAD patients was 65.5 ± 10.3 years old and mean age of patients in control group was 58.6 ± 11 years old, with a statistically significant difference (p<0.05). The proportion of patients with diabetes mellitus in the PAD group was 39%, while that in the non‑PAD group was 26.8%, and the difference was statistically significant. The analysis of clinical data after admission revealed that the levels of creatinine, TC and LDL-C were significantly higher in the PAD group than in the non-PAD (p < 0.05, for all; Table 1). Characteristics of the coronary artery: coronary angiography was performed for all included patients. Multi-vessel disease was defined as the presence of two or more main branches of the coronary artery or its major branches with ≥70% stenosis. 8,9 According to these features, the disease was divided into three types: left main coronary artery disease (≥50% stenosis in the left main trunk), total occlusion (100% vascular stenosis), and calcification. The proportion of patients with multi-vessel stenosis was 12.1% in the PAD group, significantly higher than the non-PAD group (p < 0.05). In terms of left main CAD, occlusion, calcification and bifurcation lesions, the proportion of patients with these diseases was higher in patients with ACS combined with stroke, than in patients without stroke; but the difference was not statistically significant (Table 2). Comparison of in-hospital adverse events: adverse events during in-hospital treatment included death, cardiogenic shock, acute left heart failure and cardiac rupture. In‑hospital mortality rate was statistically significantly higher in ACS patients in the PAD group (1.1%), compared with patients in the control group (0.4%) (p < 0.05, Table 3). After the patients were grouped according to the presence of the above events, the variables were selected for multivariate logistic regression analysis. The results revealed that history of PAD (OR = 1.791, p = 0.01), history of diabetes (OR = 1.223, p = 0.001), and age of >65 years old (OR = 4.670, p < 0.001) were independent risk factors for in-hospital adverse events (Table 4). Discussion There is a closecorrelationbetweenatheroscleroticheart disease and PAD. 10 Patients with PADhavemore extensive atherosclerosis, and the lesions are often more serious. Therefore, the risk of atherosclerotic events in this group is further increased. In the GRACE trial, approximately 9.7% of 41,108 ACS patients had PAD. 11 In the present study, 5,682 ACS patients were included; 188 of them (3.3%) had a history of PAD, and this proportion was lower than the proportion reported in the GRACE trial. The occurrence and development of atherosclerosis are closely correlated to age. A study revealed that PAD patients were older and had higher risk of cardiovascular disease. 12 Furthermore, the present study revealed that patients with ACS complicated with PAD was older than patients in the control group. The multivariate logistic regression analysis 368